Child Restrictions & Limitations

Please select a Restriction
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There are no restrictions on the child/children’s participation in this program. During the child/children’s participation in the C.H.E.E.R.S. Program he/she is not allowed to participate in the following activities.

Please restrict my child/children's participation in the following activities:

Child/Children's Doctor' Name
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Doctor's Phone
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Area Code Phone Number

Doctor's Address

Does your child/ children have any physical/medical conditions or allergies, which may affect the child/children’s participation in the C.H.E.E.R.S. Program.
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If Yes, please describe and explain the condition(s)

RESPONSIBILITIES, LIABILITIES AND WAIVERS

A. PARENTAL CONSENT

I give consent for my child named above to participate in the C.H.E.E.R.S. Program Activities, and I execute the above liability waiver on their behalf.

B. ATTENDEE’S RESPONSIBILITY

As the parent or lawful guardian of a child participating the in the C.H.E.E.R.S. Program, I understand that my child must agree to follow all the RULES and regulations concerning conduct and dress code. I also understand that should my child violate any of these RULES, that my child be subjected to expulsion from the C.H.E.E.R.S. Program.

C. RESPONSIBILITY FOR TRANSPORTATION TO AND FROM THE CHEERS PROGRAM

As the parent or legal guardian of a child participating in the C.H.E.E.R.S. Program, I understand and agree that it my sole responsibility as the parent or legal guardian for the transportation and safety of my child to and from the C.H.E.E.R.S. Program. I understand and agree that the City of Philadelphia, the Philadelphia Police Department, and the C.H.E.E.R.S. Program assumes no responsibility for my child during such transportation whether by private auto, public transportation or walking.

D. WAIVER, RELEASE AND ASSUMPTION OF RISK

In consideration of the acceptance of my child into the C.H.E.E.R.S. Program, I hereby waive, release, and discharge, on behalf of myself and my child, any and all claims for damages for person injury, property damages or which , may hereafter occur to me or my child as a result of participation in said Program. This release is intended to discharge in advance the City of Philadelphia, its officials, officers, employees, volunteers and agents from liability, even though that liability may arise out of perceived negligence of the part of persons mentioned above. It is understood that some recreational activities involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risk on behalf of myself and my child. It is further understood and agreed that this waiver, release and assumption of risk is to be binding on both my and my child’s heirs and assigns.

E. CONSENT FOR TREATMENT

I hereby give my consent to have my child named above treated by emergency medical personnel, a physician, or surgeons, in case of sudden illness or injury while participating in the C.H.E.E.R.S. Program. It is understood that the City of Philadelphia, the Philadelphia Police Department or the C.H.E.E.R.S. Program will provide no medical insurance for such treatment and that the cost thereof will be at my own expense.

F. PHOTO RELEASE FOR MINOR CHILDREN

As the parent or legal guardian of the above named child, I hereby authorize the Philadelphia Police Department and the C.H.E.E.R.S. Program to publish the photographs taken of me and/or the above named minor child, and our names, for use in the C.H.E.E.R.S. Program website and/or other publications and for display in the facility. I release the Philadelphia Police Department and the C.H.E.E.R.S. Program from any expectation of confidentiality for the above named child and myself and attest that I am the parent or legal guardian of the above named child and that I have the authority to authorize the Philadelphia Police Department and the C.H.E.E.R.S. Program to use their photographs and names. I acknowledge that since participation in publications and websites produced by the Philadelphia Police Department and the C.H.E.E.R.S. Program is voluntary, neither the minor child nor I will receive financial compensation. I further agree that participation in any publication and website produced by the Philadelphia Police Department and the C.H.E.E.R.S. Program confers no rights of ownership whatsoever. I release the Philadelphia Police Department and the C.H.E.E.R.S. Program its contractors, employees and volunteers from liability for any claims by me or any third party in connection with my participation or the participation of the above named child in the C.H.E.E.R.S. Program.

I have read and understand the responsibilities, liabilities, waivers and consent identified in Sections A through F on this document, and agree to all the terms and conditions.
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